Fillable New Account Application Form Individual May 282015 Fillable

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New Account Application Form Individual May 282015 Fillable

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The New Account Application Form Individual May 282015 Fillable form is 1 page long and contains:

  • 4 signatures
  • 22 check-boxes
  • 39 other fields

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File type: PDF

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New Account Application Form
Individual
PROXY APPOINTMENT
I/We hereby appoint the Chairman of the Board of Directors of the Society or any director or officer of the Society from time to time
nominated by him as my Proxy to vote for me on my behalf at all meetings of the Society. This appointment shall remain valid and effective
until revoked by me in accordance with the Rules of the Society.
ACKNOWLEDGEMENT
I/We confirm that the information given in this application is true and complete. I/We acknowledge receipt of the Terms and Conditions for
this account. I/We agree to be bound by the Terms and Conditions governing the operation of this account and by the Rules of the Society.
Signature 1:................................................................................................... Verified by:..................................................................................................
Signature 2:................................................................................................... Verified by:..................................................................................................
Signature 3:................................................................................................... Verified by:..................................................................................................
Signature 4:................................................................................................... Verified by:..................................................................................................
Processed by:................................................................................................. Checked by:.................................................................................................
To: The Directors of the Victoria Mutual Building Society
□ I/We request that I/ we be admitted as members of the Society in respect of .................................... shares.
□ I/We request to be admitted as depositor(s) of the Society.
ACCOUNT INFORMATION
A/C#:
CURRENCY: □ JA □ US □CDN □ GBP
DATE OPENED:
PRODUCT TYPE:
INITIAL DEPOSIT:
RECEIPT NO:
LOCATION:
REFERENCE NO:
INTEREST DISPOSITION: □ Capitalize □ Transfer ............. % of
interest to A/C#...................................
NO OF APPLICANTS:
SEND MAIL □ Yes □ No
PURPOSE OF ACCOUNT:
□ Business □ Education □ Savings □ Home Ownership
□ Retirement □ Other................................................................................
SOURCE OF FUNDS:
□ Business □ Inheritance □ Sale of assets □ Gift
□ Loan proceeds □ Tax refund □ Salary/wages
□ Other.....................................................................................
ACCOUNT MAILING ADDRESS
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
EXPECTED MONTHLY DEPOSITS:
EXPECTED MONTHLY WITHDRAWALS:
MANDATE OF PAYMENT:
MANDATE FOR PLEDGING FUNDS:
ACCOUNT HOLDER #1:
RELATIONSHIP CODE:
ACCOUNT HOLDER #2:
RELATIONSHIP CODE:
ACCOUNT HOLDER #3:
RELATIONSHIP CODE:
ACCOUNT HOLDER #4:
RELATIONSHIP CODE:
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New Account Application Form Individual May 282015 Fillable

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Completed 23 February 2021

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